How community counseling turned the tide of HIV/AIDS in Africa

HOW COMMUNITY COUNSELING IN THE 1990’S TURNED THE TIDE AGAINST HIV/AIDS IN AFRICA: WRITING HISTORY TODAY.

MacDonald Chaava

Feb, 2014

How Community Counseling Turned the Tide 2

In the darkness, a candle• In the late 1980s and early 1990s the heart of Africa was

very dark because of HIV/AIDS• In the most unlikely place, lessons from the most unlikely

programs began to turn the tide• One community at a time, many communities• Zambia, Uganda, Zimbabwe, Kenya, Nigeria, Ghana,

Tanzania…


What History Will SayoThe story of HIV/AIDS would have been written differently

because there was no cure, no hopeoMore people died than necessaryoThere was no short-cut; no easy pathoCommunity counseling turned the tide in the 1990soThe credit goes to a small hospital in rural Africa for

thinking out-of-the-box


Testing and Counseling• A snap survey of hospital inpatients HIV status concluded:

We Have a Problem!!• Thinking out of the box: start to warn people through

counseling• Start Testing and spread the word• Testing and counseling for individuals was established• Train health workers and prepare counselors• Rotate counselors to handle increasing workloads


Testing and Counseling for Individuals

• Tens of health professionals including Clinical Officers, nurses, para-medical staff trained as counselors in hospital

• Local teachers from primary and secondary school trained as HIV/AIDS counselors


Increasing Workload• Men, women, children of all ages diagnosed, many

admitted to hospital• Some sick at home in the villages• Some are critical, come to hospital, are admitted, begin to

clog the system• More loved ones waiting on the sick• Hospital grounds become overcrowded


Find out What People Want• A simple survey determined where patients wanted to die:

At Home, NOT in the hospital• Explains why people want to die at home• Preparation for transfer of counseling model from case

management to community counseling• Offer by donors to build a hospice turned down


Patients Want to Die At Home; Not in Hospital!• A simple Social worker’s survey determines where

patients want to die, and Why• At home they are in familiar surroundings• At home they are surrounded by loved ones• At home the loved ones can watch over their sick ones

and also do field work• At home, all the extended family members can come at

any time


Patients Don’t Want to Die in Hospital!

• A simple Social worker’s survey determines why patients don’t want to die in hospital

• In hospital they are surrounded by strangers• In hospital it means all their loved ones must leave home

to watch over them• Loved ones cannot do their field work; there will be no

harvests• In hospital, only few of the extended family members can

come at any given time• “People go to hospital to get well, not to die”


Counseling for Communities!• Practical lessons learned from ongoing leprosy

rehabilitation are tried out in the HIV/AIDS work• Birth of Home Based Care: Transfer of care from Hospital

to Household• The problem with HIV/AIDS is defined as an intricate

social dynamic that can only be unraveled through an equally sensitive culture-centric approach

• Community counseling started• Integrated multi-sector approach to HIV/AIDS established

with Chikankata Hospital as the hub• AIDS Training for international participants took root at

Chikankata Hospital


Why Community Counseling Works• Provides space for people to identify themselves as a community• Allows people of various tribes (ethnic groups), age, and gender

to think together• Provides safe spaces for community members to speak their

minds• Provides a place where people cannot be “wrong”• Provides a place where every voice counts• Provides a place where people can laugh at themselves without

feeling ashamed• Provides spaces for community to process what is going on• Creates space for community members to be accountable to one

another by mutual agreement• Helps community to look HIV/AIDS in the face: the stigma, the

loss, the orphans, the widows, the faith, and so on


How Community Counseling Works• Counseling is based on relationship• Trained facilitators enter relationship with community• Facilitators help community to begin a journey together• Entry of facilitators into community is by invitation,

recognizing role of community leadership• Entry is preceded by enrollment of leaders, explaining

why this journey is important• Facilitators use a strategic framework built solidly on

relationship• The framework for community counseling begins with

relationship building, extends into problem identification, exploration, action, and review


What was apparent• Anecdotal evidence showed that community counseling

was well received• Communities were willing to do this• Faith groups did not separate people, instead

strengthened the bonds of community• Community counseling reduced the friction within

community• Community conversations were very well attended• Community conversations generated immense talk at

funerals, at school, in church, and around the fireplace and in bedrooms

• Community conversations brought hope of a new sun-rise


The FacilitatorIs not a leadership, political, or religious position

• Has knowledge and skill-set necessary to drive the community counseling process

• Knows to respect the relationship with community• A typical community counseling facilitator is a member of

the community• Is trusted by the community• Is recognized by the community as their voice• Is the conscious of the community, reminding of

commitments made by the community


Why History will look back at the 1990s as the Turning Point• Community counseling helped many across Africa to face

their fears and overcome their inhibitions• Faith Based Organizations, Governments, NGOs, and

Community based organizations took up HBC and components of counseling

• The Community counseling model was rapidly taken to scale across Sub-Sahara Africa, Thanks to the Salvation Army


What I discovered about my African heritage (1)

My first week in England I might have been at the bus station waiting for a bus with the bus schedule in my hand, and yet, I probably turned to the guy standing near me and asked, “What time is the bus coming?”



• You see, it was not about the bus… or the schedule… it was about relationship: I wanted the guy to know me, I wanted to know him so that if we met again we would greet and say, Hi! I know you! I am your friend.

• Generally the people I did this to, hated it. They probably did not want to be known by me. They did not want to know me except as the figure who stood near them.



• In my African heritage, I tend to value relationships, trust, care, love…

• I am always conscious of relationship. It is hard work not to relate with people; it is hard work just standing there with all the strangers without looking into each other’s eyes and wondering or asking, “Do you have a mother who loves you? Are you okay today? Can I be your friend?”


HIV/AIDS makes people lonely: Community counseling counters by building relationships

Across Africa you heard sayings like these:• You are my brother/sister; I may not know you, you may

not know me• Ubuntu• I am, because you are• You are not alone; it will be okay• No one should die alone• No community should stand alone• The Answer Lies Within• You can build highways and freeways; people will

continue to walk the byways


And the Verdict: History

We have to wait until history is born in 2028!

THE END

Education

How community counseling turned the tide of HIV/AIDS in Africa